How to Structurally Reform the National Health Service to Improve Patient Outcomes


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Hold the birthday cheers: poor NHS performance costing lives

2018 marks the 70th birthday of the UK National Health Service – an institution which commands an unparalleled trust and reverence from the British people.1 Yet, to many casual onlookers, the Health Service appears to be in a perpetual state of “crisis”. To some extent, this is borne out by the available data on health outcomes and waiting times, where on many measures the NHS lags behind Western European counterparts. The consensus view amongst policymakers and the wider commentariat is that the only way to solve problems in the NHS is by increasing funding. While the NHS’s financial constraints are real, and, in the short term, cash injections might prove beneficial, without major structural reform and efficiency gains, the NHS will remain an unsustainable system, characterised by waiting lists, rationing, and mediocre patient outcomes.

Unfortunately, much-needed discussions of NHS reform are often hampered by the insular nature of healthcare debate in the UK. Perhaps most damagingly of all, universal healthcare coverage is routinely praised as a unique British achievement, although this long ago ceased to be the case. In reality, Social Health Insurance (SHI) models are common in Europe and most OECD countries. These rate more highly for public satisfaction, deliver better outcomes, while proving definitively that universal health coverage is not unique to the NHS. It is time our lawmakers did what they do in other areas of policy – namely, learning from international best practice.

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Head of Political Economy

Dr Kristian Niemietz is the IEA's Head of Political Economy. Kristian studied Economics at the Humboldt Universität zu Berlin and the Universidad de Salamanca, graduating in 2007 as Diplom-Volkswirt (≈MSc in Economics). During his studies, he interned at the Central Bank of Bolivia (2004), the National Statistics Office of Paraguay (2005), and at the IEA (2006). He also studied Political Economy at King's College London, graduating in 2013 with a PhD. Kristian previously worked as a Research Fellow at the Berlin-based Institute for Free Enterprise (IUF), and taught Economics at King's College London. He is the author of the books "Socialism: The Failed Idea That Never Dies" (2019), "Universal Healthcare Without The NHS" (2016), "Redefining The Poverty Debate" (2012) and "A New Understanding of Poverty" (2011).